title: Clinical use of a front lifting hood rectoscope tube for transanal endoscopic microsurgery.
abstract: BACKGROUND
  Transanal endoscopic microsurgery (TEM), a procedure developed by Buess et al. requires a specially designed surgical rectoscope system, and adequate training for its operation is mandatory. In order to simplify the performance of TEM, and to allow the use of additional surgical instruments and devices, we have developed a new rectoscope tube.
  
  
  METHODS
  The forward half of the tube can be opened longitudinally by hand. Our working insert platform is hollowed and includes a channel for an endoscope. The resection procedure can be performed under normal atmospheric pressure. This newly developed rectoscope system has already been employed clinically. TEM was performed using our original forward lifting hood rectoscope tube in 20 patients, including 12 cases of sessile adenoma and eight cases of early carcinoma.
  
  
  RESULTS
  The forward hood of the tube was opened to the maximum angle of 25 degrees in eight patients and 15-20 degrees in the other 12 patients. The visible field of the rectal interior was extended in direct proportion to the angle. Through our working insert platform, instruments and devices could be used for either laparoscopic or open surgery.
  
  
  CONCLUSIONS
  These modifications have made TEM easier and will therefore make the procedure available to more surgeons.
authors.affiliation: Second Department of Surgery, Fukuoka University School of Medicine, Japan.
authors.forename: Y
authors.initials: Y
authors.lastname: Yamashita
authors.forename: T
authors.initials: T
authors.lastname: Sakai
authors.forename: T
authors.initials: T
authors.lastname: Maekawa
authors.forename: T
authors.initials: T
authors.lastname: Shirakusa
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001003:Anal Canal; D019723:Endoscopes; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008866:Microsurgery / Q000295:instrumentation*; D008875:Middle Aged; D012004:Rectal Neoplasms / Q000175:diagnosis / Q000601:surgery*; D012189:Retrospective Studies; D013536:Suture Techniques; D016896:Treatment Outcome